EMPOWERING PATIENTS, ASSISTING CLINICIANS

ICARE’s intelligent control provides a movement that is neither always assistive nor always resistive. It is designed to provide an “assist as needed” approach similar to what a therapist provides physically and intuitively while gait training a patient.

The ICARE frees clinicians from hours of strenuous manual lifting and improves patient access to assistive technology, allowing them to improve their walking and fitness.

WHY ICARE?

The ICARE system’s motorised control has a sensor that automatically adjusts the level of support depending on the individual’s needs during exercise. Individuals can use ICARE in place of expensive robotic gait devices in specialised rehabilitation hospitals, medical fitness settings, outpatient therapy gyms, nursing homes, assisted living facilities, and senior centres.

The ICARE also reduces the physical stresses caregivers who deliver traditional locomotive therapy may experience.

Relearning to walk and remaining physically active are important rehabilitation goals for individuals with weakness, numbness or balance problems and those recovering from a disabling injury or illness. To regain walking ability, thousands of step-like movements are required to achieve lasting neuroplasticity gains. Often these individuals face barriers due to the lack of equipment that appropriately accommodates the needs of compromised muscles. Enter ICARE.

Developed at the Madonna Rehabilitation Hospital and Research Institute in Lincoln, Nebraska, ICARE is a fully-integrated system that provides a safe, effective method for assisting patients with neuromuscular disorders resulting from stroke, TBI, partial SCI, and other injuries or diseases. ICARE’s intelligent control provides a movement that is neither always assistive or always resistive. It is designed to provide an “assist as needed” approach that is similar to what a therapist provides physically and intuitively while gait training a patient. The ICARE frees clinicians from hours of strenuous manual lifting and advancing of the legs and expands patient access to assistive technology, allowing them to improve their walking and cardiovascular fitness.

ICARE’s leg movements closely mimic the kinematic and electromyographic (EMG) patterns of walking. Noted in development studies, ICARE training can help individuals regain or retain the flexibility and strength required for walking, particularly if the muscle demands are customised to those with weakness during rehab. Special focus was applied during development to ensure the appropriate levels of assistance are available for individuals to accomplish the required repetitions, both with partial body weight support and motor-assistance from the footplates.

Forward and reverse motor assistance allows speeds up to 65 cycles per minute

Williams NA, Burnfield JM. Psychological difficulties and parental well-being in children with musculoskeletal problems in the 2011/2012 National Survey of Children’s Health. Rehabilitation Psychology. Published online ahead of print, October 8, 2018. https://doi.org/DOI:10.1037/rep0000251

Burnfield JM, Powers CM (2003). Influence of age and gender on utilized coefficient of friction during walking at different speeds. Metrology of Pedestrian Locomotion and Slip Resistance, STP #1424:3-16.

Rawat M, Arya S, Song P, Burnfield JM, Bashford GR, Kulig K. Macro- and Micro-Morphology of Achilles Tendon in Runners with and without History of Tendinopathy. 2010 Annual Combined Sections Meeting of the American Physical Therapy Association.

Kulig K, Burnfield JM (2008). Mechanistic and interventional aspects of movement disorders: The role of biomechanics. Proceedings of the International Congress of the Polish Society of Biomechanics 2008, pgs. 11-18.

Terryberry-Spohr LS, Burnfield JM (2008). Interdisciplinary management of concussive events in high school athletes: The importance of the neuropsychologist in detection and monitoring of concussive injuries. Journal of the International Neuropsychological Society, 14 (S), 241. Merit Award.

Terryberry-Spohr, L, Fager, S, Burnfield, JM (2007). A multidisciplinary approach to providing services across the healthcare continuum for persons with traumatic brain injury. Part I – Prevention and early intervention of mild tbi and concussion: Part II – New augmentative and alternative communication options for persons with severe traumatic brain injury; Part III – Maximizing opportunities for participation, function, and health following discharge. Proceedings of the 5th Annual American Medical Rehabilitation Providers Educational Conference.

Burnfield JM, Lim P, Brault J, Flynn JE, Powers CM (2001). Comparison of utilized coefficient of friction requirements among persons of different ages during shod walking at different speeds. Proceedings of the American Society for Testing and Materials, Symposium on Metrology of Pedestrian Locomotion and Slip Resistance, pg. 15.

Powers CM, Burnfield JM (2001). Comparison of utilized coefficient of friction requirements across walking conditions. Proceedings of the American Society for Testing and Materials, Symposium on Metrology of Pedestrian Locomotion and Slip Resistance, pg. 16.

Burnfield JM. Observational Gait Analysis: How Knowledge of the Fundamentals Can Enhance Patient Outcomes. Clinical Doctorate in Physical Therapy Program, University of South Dakota. Vermillion, SD. Presented November 2014; Presented November 2013; November 2012; November 2011; October 2010; October 2009; October 2008; October 2007; November 2006 (one day course).

Burnfield JM. Patient Centered Technology for Rehabilitation. Invited Branch Lecturer for 2013. Duke University School of Medicine, Department of Community and Family Medicine, Doctor of Physical Therapy Division. Presented May 6, 2013.

Burnfield JM. Transcranial Doppler (TCD) Opportunities for Collaborative Research and Development within Physical Rehabilitation. Department of Biological Systems Engineering, University of Nebraska Lincoln. Lincoln, NE. Presented April 15, 2013.

Burnfield JM. Emerging Technologies for Physical Rehabilitation Across the Continuum of Care: Engaging the PT Community to Guide Development. Eastern District of the Nebraska Physical Therapy Association. Presented November 29, 2012.

Burnfield JM. Observational Gait Analysis: How Knowledge of the Fundamentals Can Enhance Patient Outcomes. Clinical Doctorate in Physical Therapy Program, University of South Dakota. Vermillion, SD. Presented November 2012; November 2011; October 2010; October 2009; October 2008; October 2007; November 2006 (one day course).

Burnfield JM. ICARE Training to Improve Walking and Cardiovascular Fitness for Individuals Living with Physical Disabilities and Chronic Conditions. Hospital for Special Care. New Britain, CT. Presented April 2-3, 2012.

Burnfield JM. Enhancing walking and cardiovascular fitness following a brain injury: Evidenced-based approaches for use in the rehabilitation setting and community. 2011 Brain Injury Association of Greater Kansas City Conference. Kansas City, KS. To be presented on March 31, 2011.

Burnfield JM. Developing ICARE, an Intelligently Controlled Assistive Rehabilitation Elliptical Training System to Help Individuals with Physical Disabilities and Chronic Conditions Improve Walking and Cardiovascular Fitness. Entrepreneurial Management, College of Business Administration, University of Nebraska-Lincoln. Lincoln, NE. September 16, 2010.

Burnfield JM. Observational Gait Analysis: How Knowledge of the Fundamentals Can Enhance Patient Outcomes. Clinical Doctorate in Physical Therapy Program, University of South Dakota. Vermillion, SD. October 2009, October 2008, October 2007, November 2006 (one day course).

We have had the ICARE at Brooks Rehabilitation for over 2 years now. It is one of our most highly utilised pieces of equipment. We use the ICARE to treat patients with any gait or balance impairments regardless of diagnosis; Orthopaedic, Neurologic, Geriatric, Bariatric, and Paediatric. The patients and staff love using the ICARE due to the versatility it provides as well as the ease of set up. The adjustability of speed and stride length ensure that training is customised to each patient and their specific needs. We have patients who come in just to use the ICARE in our independent programme to maintain their health and quality of life.

The staff that uses it enjoy that we can provide longer sessions of stepping with less assist from other staff and less need to muscle through a locomotor session on the treadmill. It also provides a way to increase stepping in a safe environment that we can work on functional tasks such as reaching and trunk rotations while the lower legs are moving to increase dynamic balance. Mostly, staff and patients like the fact that regardless of the level of function of the patient the ICARE provides the means to deliver a cardiovascular workout that no other machine can deliver.

We had a patient with a lumbar plexus palsy that was not able to generate a static EMG in his doctor’s office, but when using the ICARE at a higher speed was able to generate a dynamic EMG. After months of rehab using the ICARE the patient was able to return to running and playing with his children with no assistive devices. His prognosis prior to this discovery and intervention would be all standing and walking tasks would need a locking knee brace.

Overall, the ICARE is a very affordable piece of rehabilitation technology that allows any clinician to deliver a highly intense intervention that can be geared toward any patient population.

Project Walk Orlando’s mission is to provide those living with spinal cord injuries the opportunity to achieve their greatest recovery potential and an increased quality of life. Our mission is fulfilled by providing specialised one-on-one, cutting-edge, aggressive and comprehensive exercise-based programmes. The ICARE system has played an integral role in helping our clients and staff achieve this mission.

The ICARE system is utilised on a daily basis during clients exercise programmes to provide an intensive cardiovascular and gait training workout. From a client and staff perspective, the ICARE has been a successful addition to our facility, allowing for an efficient setup and for the trainer to ensure the client is in a comfortable and safe position. Clients are able to achieve thousands of steps on the ICARE system which supports the repetitive movement science of SCI training. In addition to this, clients are able to make use of the feedback function where if they move the elliptical faster than the motor speed the machine lets them know. This function always increases their effort and motivation during the workout.

Various factors weighed into the decision to fundraise and purchase the ICARE System for PWO. These include the systems ability to improve our clients’ fitness, circulation and function in a manner which is less labour intensive on trainers. The ICARE can provide our clients with 1000’s of steps that would typically require multiple trainers, assistants and a lot of time.

HEAR FROM PATIENTS

ICARE SYSTEM FEATURES

HAND HOLDS

LEVELS OF ASSISTANCE

ADJUSTABLE SPEED

STEP LENGTH

FOOT PEDALS

BODY WEIGHT SUPPORT SYSTEM

REVERSE TRAINING

Judith M. Burnfield, Ph.D., P.T., is Director of the Institute for Rehabilitation Science and Engineering, Director of the Movement and Neurosciences Center and the Clifton Chair in Physical Therapy and Movement Sciences at Madonna Rehabilitation Hospital. Dr. Burnfield earned her Ph.D. in Biokinesiology from the University of Southern California and completed her post-doctoral training at the Pathokinesiology Laboratory at Rancho Los Amigos National Rehabilitation Center. Dr. Burnfield holds adjunct faculty appointments at Creighton University, the University of Nebraska – Lincoln, University of Nebraska Medical Center, and the University of South Dakota.

Dr. Burnfield’s research aims to 1) enhance the independence and quality of life of individuals with and without disabilities, emphasising locomotive disorders such as gait; 2) prevent secondary medical complications in persons with chronic medical conditions; and 3) expand rehabilitation therapists’ capacity to meet existing, evolving, and future societal health care needs through development and application of clinical innovations and technology. Her teaching emphasis includes normal and pathologic gait, orthotics, prosthetics, and biomechanics.